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Shrier LA, O'Connell MM, Torres A, Shone LP, Fiks AG, Plumb JA, Maturo JL, McCaskill NH, Harris D, Burke PJ, Felt T, Murphy ML, Sherritt L, Harris SK. Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55039. [PMID: 38530346 PMCID: PMC11005433 DOI: 10.2196/55039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. OBJECTIVE This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. METHODS We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. RESULTS The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. CONCLUSIONS Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. TRIAL REGISTRATION ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55039.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Madison M O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Laura P Shone
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Julia A Plumb
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jessica L Maturo
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Nicholas H McCaskill
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Donna Harris
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Thatcher Felt
- Yakima Valley Farm Workers Clinic, Grandview, WA, United States
| | | | - Lon Sherritt
- Cornerstone Systems Northwest, Lynden, WA, United States
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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O'Connell M, Gluskin B, Parker S, Burke PJ, Pluhar E, Guss CE, Shrier LA. Adapting a Counseling-Plus-mHealth Intervention for the Virtual Environment to Reduce Sexual and Reproductive Health Risk Among Young Women with Depression. Prev Sci 2023; 24:196-208. [PMID: 36881344 PMCID: PMC9989584 DOI: 10.1007/s11121-023-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
MARSSI (Momentary Affect Regulation - Safer Sex Intervention) is a counseling-plus-mobile health (mhealth) intervention to reduce sexual and reproductive health (SRH) risks for women with depression and high-risk sexual behavior. Due to the COVID-19 pandemic limiting in-person care, we sought to develop the counseling and mhealth app onboarding for virtual implementation. A team with SRH, adolescent medicine, motivational interviewing, cognitive behavioral therapy, and technology expertise adapted the counseling through an iterative consensus process. We identified essential aspects of the counseling, specified the content so the counseling could be delivered in person or virtually with fidelity, and considered best practices for telehealth for the focus population. Virtual counseling retained key elements from in-person counseling while including enhancements with engaging visual and audio-video aids. Instructions and programming were developed to support virtual counseling delivery and onboarding for the mhealth app component of MARSSI. After testing the virtual format in mock sessions, we implemented a small-scale feasibility study in an adolescent medicine clinic with women with depressive symptoms and high-risk sexual behavior age 18-24 years (N = 9). Participants experienced minimal technical difficulties and expressed satisfaction with the virtual format, and all were able to complete app onboarding successfully. Expanding delivery options for SRH interventions to include virtual can improve access, particularly for populations with psychological and environmental barriers to care.
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Affiliation(s)
- Maddie O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Brittany Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Bouvé College of Health Sciences, School of Nursing, Northeastern University, Boston, MA, USA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Darharaj M, Roshanpajouh M, Amini M, Shrier LA, Habibi Asgarabad M. The effectiveness of mobile-based ecological momentary motivational enhancement therapy in reducing craving and severity of cannabis use disorder: Study protocol for a randomized controlled trial. Internet Interv 2023; 34:100669. [PMID: 37746638 PMCID: PMC10514405 DOI: 10.1016/j.invent.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
Objective This study aims to investigate the effectiveness of Ecological Momentary Motivational Enhancement Therapy (EM-MET) in reducing craving and severity of Cannabis Use Disorder (CUD) among young adults. Methods This multicenter, single-blinded randomized controlled trial (RCT) will be conducted over a period of 11 weeks. Eighty patients with CUD will be randomly assigned to two equal-sized parallel groups, either the Motivational Enhancement Therapy (MET) group or the EM-MET group. All participants will receive four individual face-to-face sessions of MET (twice a week). The MET group will not receive any other treatments after these sessions; however, in the EM-MET group, the top triggers of patients will be assessed using mobile-based Ecological Momentary Assessment (EMA) five times a day within three weeks (after face-to-face sessions) and they will receive a call from the therapist who provides them with EM-MET (in the form of an emergency telephone helpline) as soon as they report experiencing triggers of cannabis use that are assessed using EMA in their everyday lives. Primary outcomes including CUD severity and the severity of craving will be evaluated using the Leeds Dependence Questionnaire and the Self-efficacy and Temptation Scale, respectively. These assessments will be conducted at pre-treatment, post-treatment, and a six-week follow-up. Discussion If proven feasible and effective, the results of this study will offer clinicians an evidence-based treatment approach to address craving and dependency in patients with CUD. Moreover, these patients will receive effective treatment in real time and in real life, when and where it is most needed. However, it is important to consider the limitations of this study, such as the specific population studied in Tehran, Iran, which may affect the generalizability of the results. Nevertheless, the implementation of Ecological Momentary Interventions (EMIs) in real-life settings holds promise for timely and effective treatment.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials on 21 February 2023. Registry No. IRCT20221224056908N1.
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Affiliation(s)
- Mohammad Darharaj
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Roshanpajouh
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Amini
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Positive Youth Development Lab, Human Development & Family Sciences, Texas Tech University, TX, USA
- Center of Excellence in Cognitive Neuropsychology, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
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Gluskin BS, O’Connell M, Falk G, Shrier LA, Guss CE. COVID-19 impacts and videoconference healthcare preferences in relation to depression and sexual risk behaviors among young adults assigned female at birth: a cross-sectional study. Mhealth 2023; 9:15. [PMID: 37089271 PMCID: PMC10119438 DOI: 10.21037/mhealth-22-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Background Due to decreased access to sexual and reproductive health (SRH) services and an increase in depressive symptoms, the coronavirus disease 2019 (COVID-19) pandemic has exacerbated the risk of unsafe sexual behaviors among already vulnerable young adults assigned female at birth (AFAB). Despite its potential for improving SRH outcomes, little is known about how young adults view virtual SRH counseling. We designed a survey to examine these perspectives and further characterize pandemic-associated changes in mood and healthcare access in young adults AFAB. Methods Patients of a Midwest family planning organization who were AFAB and aged 21-24 years were recruited via convenience sampling between May and September 2021. Participants answered survey questions about how they perceived that the pandemic had affected their mood and healthcare access. The Patient Health Questionnaire (PHQ)-8 assessed depressive symptoms. Additional questions probed SRH risk behaviors and experience with and opinions on virtual healthcare and research. Non-responses to questions were not included in analyses. Associations among these variables were analyzed using non-parametric bivariate tests (chi-square and Mann-Whitney U). Results One hundred twenty people participated in the survey. Participants had a median age of 22 years and self-identified predominantly as female and White. Three-quarters of respondents reported their mood worsened as a result of the pandemic and more than 3 in 10 had depression. Those reporting pandemic-worsened mood had more severe depressive symptoms than those who did not (U=722.500, P=0.005). Most reported sexual intercourse in the past 3 months, nearly all of whom reported at least one SRH risk. Pandemic mood impacts were not associated with SRH risk. One in four participants reported pandemic-associated difficulty accessing healthcare, which was not associated with depression or SRH risk. Most reported comfort with videoconference healthcare, including technology, speaking with a provider, and having enough privacy. Conclusions The COVID-19 pandemic has increased depression and SRH risk among young adults AFAB and, at the same, impeded their access to healthcare. The study findings suggest that no matter the degree of depression or presence of SRH risk, videoconferencing may be an acceptable option for advancing research and addressing unmet SRH needs in this population.
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Affiliation(s)
- Brittany S. Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Maddie O’Connell
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | | | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Carly E. Guss
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Shrier LA, Harris SK. Associations of Momentary Mindfulness With Affect and Cannabis Desire in a Trial of Cannabis Use Interventions With and Without Momentary Assessment. J Adolesc Health 2023; 72:126-129. [PMID: 36272891 PMCID: PMC10870980 DOI: 10.1016/j.jadohealth.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Mindfulness, awareness resulting from attending to the present without judgment, has been associated with improved health. When considered as a time-varying momentary state, mindfulness is associated with other momentary states such as affect. We examined whether momentary mindfulness, specifically mindful attention and awareness (MAA), changed after counseling interventions to reduce cannabis use that included ecological momentary assessment (EMA) and explored associations with negative affect, positive affect, and cannabis desire. METHODS Outpatients 15-24 years using cannabis ≥3x/week were randomized to one of the three interventions, each including two motivational enhancement therapy (MET) sessions. For two interventions, MET was followed by 2 weeks of EMA (with/without messaging). Momentary MAA, negative affect, positive affect, and cannabis desire were assessed over 1 week of EMA at baseline and 3-month follow-up (N = 1,971 reports, 68 participants). We examined changes in momentary MAA from baseline to follow-up overall and by group (MET + EMA, MET-only) using generalized linear mixed effects models. We tested associations of momentary MAA with momentary affect and cannabis desire using generalized estimating equations. RESULTS Momentary MAA increased from baseline to follow-up after MET counseling plus EMA (β = 0.237), but did not change with MET counseling alone. Higher momentary MAA was associated with lower negative affect (β = -0.526) and cannabis desire (β = -0.521), but not with positive affect. DISCUSSION Among youth using cannabis frequently, momentary MAA was increased 3 months after interventions with EMA after counseling and was inversely associated with momentary negative affect and momentary cannabis desire. Mindfulness may be a useful target for momentary intervention.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Vargas G, Shrier LA, Chadi N, Harris SK. High-Potency Cannabis Use in Adolescence. J Pediatr 2023; 252:191-197.e1. [PMID: 35977620 DOI: 10.1016/j.jpeds.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Gabriela Vargas
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Center for Adolescent Behavioral Health Research, Boston Children's Hospital, Boston, MA
| | - Nicholas Chadi
- Université de Montréal, Montréal, Quebec, Canada; Ste-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Sion K Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Center for Adolescent Behavioral Health Research, Boston Children's Hospital, Boston, MA
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Johnson KA, Shrier LA, Eiduson R, Parsa N, Lilly M, D'Angelo E, Straus JH, Woodberry KA. Depressive symptom screening and endorsement of psychosis risk-related experiences in a diverse adolescent and young adult outpatient clinic in the US. Schizophr Res 2022; 248:353-360. [PMID: 34840005 DOI: 10.1016/j.schres.2021.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early identification and intervention is a gold standard for psychotic disorders, for which delays in care can have serious consequences. Screening for psychosis in primary care may circumvent barriers related to stigma and facilitate shorter pathways to care. Yet, there is debate regarding the benefit-risk balance for psychosis screening in general adolescent populations. METHODS Primary care patients of an adolescent/young adult medical clinic in the US ages 14-21 self-administered surveys assessing age, sex, receipt of psychotherapy, and occurrence, frequency (1-5), and distress (0-3) for 23 psychosis risk (PR) symptoms, including 6 general/nonspecific items and 17 psychosis-specific items. Participants also completed the 9-item Patient Health Questionnaire (PHQ-9); scores of ≥10 suggested clinically significant depressive symptoms. Analyses characterized PR symptoms and examined associations of PR symptom distress with current therapy and depressive symptom severity. RESULTS Of 212 patients who completed the survey, 75% endorsed ≥1 PR symptom and 27% rated ≥3 on distress for psychosis-specific items. Those with high PHQ-9 scores reported higher PR distress overall (t = -6.1, df = 52.3, p < 0.001) but not on psychosis-specific items such as hallucinations and suspiciousness. One in 9 participants reported heightened PR distress without being in therapy or having high depressive symptoms. CONCLUSIONS Most adolescents in this primary care sample endorsed symptoms associated with PR. Distress related to these symptoms was less common but occurred even in the absence of depressive symptoms. PR screening only in youth with high depressive symptom screens or in mental health care may miss youth needing further assessment for psychosis.
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Affiliation(s)
- Kelsey A Johnson
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Lydia A Shrier
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Megan Lilly
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA
| | - Eugene D'Angelo
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John H Straus
- Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA, USA
| | - Kristen A Woodberry
- Beth Israel Deaconess Medical Center Department of Psychiatry, Boston, MA, USA; Maine Medical Center, Center for Psychiatric Research, Portland, ME, USA; Tufts School of Medicine, USA; Harvard Medical School, Boston, MA, USA
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Freizinger M, Jhe GB, Dahlberg SE, Pluhar E, Raffoul A, Slater W, Shrier LA. Binge-eating behaviors in adolescents and young adults during the COVID-19 pandemic. J Eat Disord 2022; 10:125. [PMID: 36002838 PMCID: PMC9399990 DOI: 10.1186/s40337-022-00650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and subsequent public health measures have resulted in a worsening of eating disorder symptoms and an increase in psychological distress. The present study examined symptoms and behaviors in adolescents and young adults with emotional eating, bingeing behaviors and binge eating disorder during the pandemic. Additionally, the study explored if individuals who experienced pandemic-related food availability and food affordability issues experienced increased binge-eating symptoms and negative feelings. METHOD Participants (n = 39) were a convenience sample who participated between November 2020 and January 2021 in a weight and lifestyle management program at an urban New England pediatric hospital. Participants completed online surveys that assessed (1) participant's exposure to COVID-19 related stress and binge-eating behaviors using the COVID-19 Exposure and Family Impact Survey-Adolescent and Young Adult Version (CEFIS-AYA) and the Binge Eating Scale (BES) respectively, (2) participants' and their families' ability to attain and afford food and its association with bingeing behaviors, and (3) the relationship between food availability and affordability and negative emotions. RESULTS Nearly half of all participants (48.7%) reported moderate to severe bingeing during the COVID-19 pandemic; those who experienced greater COVID-related stress reported more binge-eating behaviors (p = 0.03). There were no associations between indicators of food availability and affordability and binge eating or between food availability and affordability and negative feelings. CONCLUSIONS Higher pandemic-related stress was associated with more binge-eating behaviors among adolescents and young adults. These results underscore the need to monitor symptoms and provide treatment for these patients despite barriers to care imposed by the COVID-19 pandemic. Research and clinical care for adolescents and young adults with EDs must recognize and respond to pandemic effects across the weight and disordered eating spectrum.
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Affiliation(s)
- Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. .,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, 5th Floor, Boston, MA, USA.
| | - Grace B Jhe
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Suzanne E Dahlberg
- Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Emily Pluhar
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Amanda Raffoul
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Wallis Slater
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Lydia A Shrier
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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O'Connell M, Levy S, Shrier LA, Harris SK. Trends in cannabis-related attitudes and behaviors among cannabis-using adolescent and young adult outpatients following medical cannabis legalization in Massachusetts. Subst Abus 2022; 43:328-335. [PMID: 34214413 PMCID: PMC9996751 DOI: 10.1080/08897077.2021.1941517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Among youth already using cannabis, legalization of medical cannabis may influence cannabis-related attitudes and behaviors, including increasing access through use of someone else's medical cannabis (diversion). Objective: To examine cannabis-related attitudes and behaviors (including diverted cannabis use) in cannabis-using youth in the four years following medical cannabis legalization. Additionally, we investigated characteristics of youth who used vs. did not use diverted medical cannabis. Methods: Data were collected in Boston from 2013 (when medical cannabis legislation took effect in Massachusetts) through 2016 (when recreational cannabis use became legal in Massachusetts). Cannabis-using youth (age 13-24) presenting to an outpatient adolescent substance use treatment program (ASUTP) or recruited for an adolescent medicine clinic study (AMCS) completed a confidential survey on demographic characteristics and cannabis use behaviors and attitudes. We used multiple logistic regression to analyze changes in attitudes and behaviors over three years versus the reference year (2013), controlling for demographics. We used chi-square to compare characteristics of youth reporting use of diverted medical cannabis versus those not. Results: The sample included 273 cannabis-using youth (ASUTP n = 203, AMCS n = 70; 2013 n = 67, 2014 n = 67, 2015 n = 77, 2016 n = 62). Mean ± SD age was 18.2 ± 2.5 years, 32% were female, 58% were White non-Hispanic, and 70% had college-graduate parents. In 2013, most youth reported that cannabis was easy to obtain (97.9%), and that occasional cannabis use had "no" or "slight" risk of harm (89.4%), with little change across years. In 2016, 44% of youth reported using someone else's medical cannabis, versus 15% in 2013 (aOR 4.66, 95% CI 1.81, 11.95). Youth using diverted medical cannabis had higher likelihood of reporting riding with a driver, or driving themselves, after cannabis use (both p < .01). Conclusion: Among at-risk youth in Massachusetts, use of diverted medical cannabis increased after medical cannabis legalization, and those using diverted medical cannabis reported higher risk for cannabis-related traffic injury.
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Affiliation(s)
- Maddie O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sharon Levy
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sion K Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Eiduson R, Heeney MM, Kao PC, London WB, Fleming MD, Shrier LA. Prevalence and Predictors of Iron Deficiency in Adolescent and Young Adult Outpatients: Implications for Screening. Clin Pediatr (Phila) 2022; 61:66-75. [PMID: 34796723 DOI: 10.1177/00099228211059647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current screening guidelines may not be adequate to identify iron deficiency (ID) and iron deficiency anemia (IDA) in adolescent and young adults. Adolescent and young adult outpatients from 4 hospital-based clinics (N = 493) reported on diet, health, and bleeding, and had phlebotomy for iron and hematologic tests. We examined sex-specific factors associated with ID and IDA and ability of universal and risk factor-based screening using hemoglobin and hemoglobin plus ferritin to detect ID and IDA. Among females (n = 350), 34.6% had ID and 6.3% had IDA. Nearly 1 in 3 females with ID had no risk factors. Among males, 12.6% had ID; none had IDA. More than 1 in 3 males with ID did not have risk factors. Current screening approaches would have missed ID in 47% to 82% of females and 95% to 100% of males. ID was prevalent in both male and female adolescents and young adult outpatients. New approaches to screening for ID are needed to accurately evaluate iron status in this population.
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Affiliation(s)
| | - Matthew M Heeney
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Pei-Chi Kao
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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Woodberry KA, Johnson KA, Shrier LA. Screening for Early Emerging Mental Experiences (SEE ME): A Model to Improve Early Detection of Psychosis in Integrated Primary Care. Front Pediatr 2022; 10:899653. [PMID: 35757126 PMCID: PMC9226538 DOI: 10.3389/fped.2022.899653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success, identifying only a fraction of these individuals within the recommended 3- to 6-month window. Broader public health strategies such as population screening are hampered by low base rates and poor self-report screen specificity. Screening for Early Emerging Mental Experiences (SEE ME) is a three-stage "SCREEN-TRIAGE-ENGAGE" model for the early detection of psychosis in integrated primary care adolescent and young adult patients during the period of peak onset. It builds on the KNOW THE SIGNS-FIND THE WORDS-MAKE THE CONNECTION framework outlined on psychosisscreening.org and developed with input from community collaborators. Systematic screening aims to expand the reach of early detection and reduce reliance on provider knowledge. Triage and engagement by trained mental health clinicians aims to improve the specificity of screen responses, enhance engagement in appropriate care, and reduce provider burden. Leveraging the low stigma of primary care, its reach to non-help-seeking adolescents and young adults, and the mental health training of clinicians within integrated care practices, SEE ME has potential to improve the benefit/risk ratio of early detection of psychosis by improving both the sensitivity and specificity of screening and clinical response. We review the rationale and design of this promising model.
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Affiliation(s)
- Kristen A Woodberry
- Center for Psychiatric Research, MaineHealth, Portland, ME, United States.,Department of Psychiatry, Tufts School of Medicine, Boston, MA, United States
| | - Kelsey A Johnson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Lydia A Shrier
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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12
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Levy S, Wisk LE, Chadi N, Lunstead J, Shrier LA, Weitzman ER. Validation of a single question for the assessment of past three-month alcohol consumption among adolescents. Drug Alcohol Depend 2021; 228:109026. [PMID: 34536715 DOI: 10.1016/j.drugalcdep.2021.109026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use is increasingly used in clinical care. Despite its endorsement by several professional societies, the U.S. Preventive Services Task Force has found the evidence base for adolescent SBIRT to be insufficient. A measure of substance use that is brief enough to embed in the electronic medical record could be used in pragmatic trials that enroll large numbers of primary care patients, facilitating research in this area. METHODS Participants aged 14-18 years (N = 492) completed an electronic survey that included a 90-day Timeline Follow Back (TLFB) Calendar, considered the criterion standard, along with three survey questions about the frequency of their alcohol use: days of use in the past three months, average days of use per week in the past three months, and average days of use per month in the past year. We calculated the correlation between the number of days reported on each of the three questions and the total number of days of use reported on the TLFB. RESULTS The question on number of days of use in the past three months was highly correlated with alcohol consumption frequency on the 90-day TLFB assessment (rho = 0.903). Other items displayed lower but satisfactory correlation with the TLFB (rho = 0.719-0.830). CONCLUSIONS A single question about past 3-month frequency of alcohol use was highly correlated with alcohol use frequency on the criterion standard TLFB among adolescents presenting for routine primary care.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Lauren E Wisk
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Julie Lunstead
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lydia A Shrier
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
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13
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Levy S, Tennermann N, Marin AC, Wiseblatt A, Shrier LA, Garvey K, Dedeoglu F, Fishman LN, Weitzman ER. Safety Protocols for Adolescent Substance Use Research in Clinical Settings. J Adolesc Health 2021; 68:999-1005. [PMID: 32994123 DOI: 10.1016/j.jadohealth.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Research involving adolescent risk behaviors must balance data confidentiality with participant safety when risky behaviors are revealed. This report details a safety protocol and reports the experience of two contemporaneous studies that used it with variant safety thresholds. METHODS We developed a safety protocol for research with adolescent patients and used it in two concurrent studies of adolescent patients, aged 14-18 years. Study "PC" recruited participants from a primary care adolescent medical clinic (N = 490), and Study "SP" recruited participants from subspecialty pediatric clinics (N = 434); both studies involved a similar self-administered assessment of health behaviors. The protocol sets thresholds for clinical intervention (positive safety flags) for past 3-month heavy alcohol consumption (Study PC: 10 or more drinks and Study SP: "binge-"level drinking), illicit drug use other than marijuana and alcohol in combination with a substance other than marijuana, and sets a positive screen for depression. We examined the rates of positive safety flags in both protocol settings, used significance testing to describe demographic differences between participants with and without positive flags in both studies, and described clinician experiences with protocol implementation. RESULTS In studies PC/SP, .6%/8.8% of participants were flagged for heavy alcohol consumption, respectively; .2%/0% for illicit drug use, 2.2%/.7% for combination substance use, and 14.9%/4.8% for depression. Some clinicians found managing positive flags challenging, although both studies completed recruitment on time and without serious adverse events. CONCLUSIONS The protocol was feasible in clinical settings. The findings and experiences documented in this report could be useful for future protocols.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Nicole Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra C Marin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Aria Wiseblatt
- Adolescent Substance use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Lydia A Shrier
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Katharine Garvey
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, Massachusetts
| | - Laurie N Fishman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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Lin JA, Harris SK, Shrier LA. Trait mindfulness and cannabis use-related factors in adolescents and young adults with frequent use. Subst Abus 2021; 42:968-973. [PMID: 33798028 DOI: 10.1080/08897077.2021.1901179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mindfulness-based interventions (MBIs) are effective in adult substance-use treatment and may be helpful for adolescents and young adults (AYAs). One target of MBIs is to improve trait mindfulness, which has been associated with better lifestyle and health outcomes. To inform MBIs for reducing cannabis use in AYAs, we sought to identify how trait mindfulness was associated with cannabis-related problems and quit attempts, as well as with motivation to change use in youth who report frequent use. Methods: Participants aged 15-24 years using cannabis ≥ 3x/week were recruited from AYA clinics in a northeastern US city to participate in a cannabis-use intervention pilot, randomized trial. At baseline, we assessed cannabis-use history, problems associated with use, attempts to quit, and trait mindfulness. All participants were offered two sessions of motivational enhancement therapy, during which they rated motivation to quit cannabis. Regression analyses were conducted to assess associations between trait mindfulness and cannabis use-related problems, attempts to quit, and motivation to change. Results: Seventy participants, mean age 20.7 ± 1.9 years, enrolled. Sixty percent identified as female, 47% as Black non-Hispanic, and 31% as Hispanic. Participants started using cannabis at mean age 15.0 ± 2.8 years and were using ≥ 3x/week by 17.0 ± 2.3 years. Higher mindfulness scores were associated with fewer cannabis-related problems (p = 0.004) and fewer quit attempts (p = 0.035). The number of cannabis-related problems did not significantly mediate the relationship between mindfulness and quit attempts. Trait mindfulness did not predict motivation to change cannabis use. Conclusions: Among AYAs using cannabis frequently, higher trait mindfulness was associated with both fewer cannabis use--related problems and fewer quit attempts. Future research should assess whether trait mindfulness is an appropriate target for decreasing cannabis use and the utility of MBIs for reducing cannabis-use behaviors.
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Affiliation(s)
- Jessica A Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Center for Adolescent Substance Use and Addiction Research, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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15
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Shrier LA, Burke PJ, Jonestrask C, Katz-Wise SL. Applying systems thinking and human-centered design to development of intervention implementation strategies: An example from adolescent health research. J Public Health Res 2020; 9:1746. [PMID: 33117757 PMCID: PMC7582103 DOI: 10.4081/jphr.2020.1746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
Introducing innovative health interventions into clinic settings requires a comprehensive and creative approach to multiple implementation challenges. To optimize implementation of a sexual and reproductive health intervention for young women with depression, we applied systems thinking and human-centered design thinking methods to develop tools and strategies to address issues influencing intervention implementation in diverse clinics. We recruited staff from three clinics that provide sexual and reproductive health and behavioral health care to young women. Across five sessions (four video conference calls, one in-person workshop), we used systems mapping to identify key stakeholders and their relationships, processes, and challenges to care; formed clinic staff-investigator design teams; brainstormed about challenges that would influence intervention implementation and considered potential solutions; prioritized implementation challenges; and designed prototypes of solutions. Participants responded positively to the systems thinking perspective and collaborative design thinking process. Findings included generalizable considerations about solving implementation challenges for clinic-based interventions, such as forming a team of champions representing the diverse disciplines involved in and impacted by intervention implementation, and creating multiple tools and strategies for implementation that can be tailored to a given clinic’s culture. Significance for public health Implementing innovative health interventions in clinic systems requires consideration of multiple human, environmental, and process factors. To develop implementation tools and strategies for a sexual and reproductive health intervention for young women with depression, we applied systems thinking to consider clinic system elements and their connections, and human-centered design to tackle challenges with intervention implementation by centering on the clinic staff who would be experiencing these challenges. Using this approach, the investigators and clinic staff efficiently and effectively identified implementation challenges in diverse clinic settings and designed tools and strategies to overcome these challenges. This form of investigator-clinic staff collaboration, attention to system factors, and focus on creative solutions can inform research and care around implementing novel interventions in established clinical systems.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA.,Department of Nursing, Northeastern University, Boston, MA
| | | | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA.,Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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16
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Levy S, Weitzman ER, Marin AC, Magane KM, Wisk LE, Shrier LA. Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care. Subst Abus 2020; 42:388-395. [DOI: 10.1080/08897077.2020.1803180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Boston, MA, USA
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Elissa R. Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA
| | - Alexandra C. Marin
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Kara M. Magane
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Lauren E. Wisk
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Lydia A. Shrier
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
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17
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Katz-Wise SL, Gordon AR, Burke PJ, Jonestrask C, Shrier LA. Healthcare Clinician and Staff Perspectives on Facilitators and Barriers to Ideal Sexual Health Care to High-Risk Depressed Young Women: A Qualitative Study of Diverse Clinic Systems. J Pediatr Adolesc Gynecol 2020; 33:363-371. [PMID: 32145377 DOI: 10.1016/j.jpag.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/22/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE This study identified clinician and clinic staff perspectives on facilitators and barriers to providing sexual and reproductive health (SRH) care to depressed young women, a population at increased risk for adverse SRH outcomes. DESIGN We conducted in-person semi-structured qualitative interviews, which were audio-recorded, transcribed, and coded by two researchers. We used thematic analysis to identify themes pertaining to care facilitators and barriers within a socio-ecological framework. SETTING This study was conducted in seven diverse clinics in the U.S. New England region. PARTICIPANTS Participants were 28 clinicians and staff (4/clinic), including behavioral health clinicians (n = 9), nurse practitioners (n = 7), nurses (n = 3), medical doctors (n = 3), administrative associates (n = 2), practice managers (n = 2), family planning counselor (n = 1), and medical assistant (n = 1). MAIN OUTCOME MEASURES We queried how clinicians and clinic staff identify and manage depression and sexual risk, and what they perceive as facilitators and barriers affecting provision of ideal SRH care to depressed young women. RESULTS Themes represented facilitators of and barriers to providing ideal SRH care to high-risk depressed young women at five socio-ecological levels: individual (facilitator: trust in providers; barrier: stigma experiences), interpersonal/provider (facilitator: frequent patient-provider communication; barrier: lack of time during clinic visits to build trust), clinic (facilitator: integration of care; barrier: lack of scheduling flexibility), organization/community (facilitator: training for providers; barrier: funding constraints), and macro/societal (facilitator: supportive policies; barrier: mental health stigma). CONCLUSION Optimizing SRH care to high-risk depressed young women necessitates attention to factors on all socio-ecological levels to remove barriers and bolster existing facilitators of care.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Allegra R Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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Shrier LA, Burke PJ, Parker S, Edwards R, Jonestrask C, Pluhar E, Harris SK. Development and pilot testing of a counseling-plus-mHealth intervention to reduce risk for pregnancy and sexually transmitted infection in young women with depression. Mhealth 2020; 6:17. [PMID: 32270009 PMCID: PMC7136654 DOI: 10.21037/mhealth.2019.11.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Depressed young women have elevated rates of unintended pregnancy and sexually transmitted infections (STIs). The objective of this study was to develop and pilot-test a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk in young women with depressive symptoms. METHODS Using the Behavior-Determinants-Intervention logic model, we developed the Momentary Affect Regulation-Safer Sex Intervention (MARSSI) to address the challenges that depression imposes on SRH risk reduction efforts of high-risk young women: (I) in-person counseling using motivational interviewing (MI) to elicit motivation for safer sex and develop a behavior change plan, and teaching cognitive-behavioral skills to manage negative thoughts and affective states; (II) 4-week Ecological Momentary Intervention (EMI) on a smartphone to report momentary phenomena related to depression and SRH risk, and receive personalized, tailored messages prompting healthy behaviors and encouraging cognitive-behavioral skill use when risk-related cognitions and negative affect are reported; and (III) booster counseling to review behavior change goals and plans and teach a new cognitive-behavioral skill. We developed the counseling through iterative interviews with 11 participants and developed the EMI through a 2-week trial with three participants, then revised MARSSI to reflect participant feedback. We next conducted a pilot-test among depressed, high-risk female adolescent clinic patients age 15-24. Pilot participants completed mental health, motivation to change behavior, and SRH behavior assessments and provided feedback at baseline, post-EMI, and at 3-month follow-up. We analyzed participant retention, counseling duration, app engagement, intervention quality ratings, and participant feedback, and compared mental health and SRH risk behavior across the study. RESULTS Seventeen participants completed the initial counseling session, 15 participated in the EMI, 14 returned for the booster session, and 14 completed the 3-month follow-up. App engagement was high for all 4 EMI weeks (≥1 report/day for median ≥6 days/week). Post-intervention, most or all participants agreed with each positive statement about the messages, reported "Excellent" MARSSI usefulness, and attributed improvements to MARSSI. Compared to baseline, post-EMI depressive symptoms, confidence to change self-selected risk behavior, and confidence to use the cognitive restructuring skill improved. At 3 months, depressive symptom scores remained lower and confidence to use cognitive restructuring remained higher, compared to baseline. Participants also reported lower frequency of sex, lower proportion of condom-unprotected sex events, and, among those using effective contraception, more consistent condom use at 3-month follow-up vs. baseline. CONCLUSIONS MARSSI was feasible, acceptable, and engaging to young women with depression and SRH risk behavior, and was associated with increased confidence to reduce SRH risk, decreased SRH risk behaviors, increased confidence to use cognitive restructuring, and decreased depressive symptoms over 3 months. Future research is warranted to evaluate MARSSI's efficacy to improve motivation, skills, affect, and behaviors, as well as reproductive health outcomes in high-risk depressed young women.
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Affiliation(s)
- Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Pamela J. Burke
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Rori Edwards
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Kells M, Burke PJ, Parker S, Jonestrask C, Shrier LA. Engaging Youth (Adolescents and Young Adults) to Change Frequent Marijuana Use: Motivational Enhancement Therapy (MET) in Primary Care. J Pediatr Nurs 2019; 49:24-30. [PMID: 31473464 DOI: 10.1016/j.pedn.2019.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/04/2019] [Accepted: 08/13/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize information elicited from adolescent/young adults with frequent cannabis use in Motivational Enhancement Therapy (MET), and determine whether differences exist across stages of change (SOC) for reducing use. DESIGN AND METHODS Primary care patients 15-24 years old using cannabis ≥3 times/week enrolled in a pilot randomized intervention trial. All youth were offered two 1-hour MET sessions. Content analysis was used to code and categorize main reasons for use, alternative behaviors, goals, values, pros and cons of change, and compared results between youth in Pre-Contemplation vs. Contemplation SOC. RESULTS Fifty-six youth completed MET session 1, 46 completed session 2. Most reported their main reason for use was related to emotional coping, negative feelings were a top-3 trigger, and distraction was an alternative way to meet their needs. Youth most frequently described progress in education or career/job as 1-year goals. More than half identified family as a very important value. They most frequently reported pros of using less related to achieving goals, self-improving, and saving money, and a con related to stress/coping. Compared to youth in Pre-Contemplation SOC, those in Contemplation were more likely to identify relationships as both a pro and con of using less cannabis. CONCLUSIONS MET can reveal developmentally appropriate goals, healthy values, and ambivalence about cannabis use that can be used to facilitate movement along the stages of behavior change toward reduction/cessation. PRACTICE IMPLICATIONS Brief motivational therapy can be used in primary care to gather information important in helping youth to reduce cannabis use.
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Affiliation(s)
- Meredith Kells
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America.
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America; Northeastern University Bouve College of Health Sciences, School of Nursing, United States of America
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America; Northeastern University Bouve College of Health Sciences, School of Nursing, United States of America
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States of America; Department of Pediatrics, Harvard Medical School, United States of America
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Burke PJ, Katz-Wise SL, Spalding A, Shrier LA. Intimate Relationships and Sexual Behavior in Young Women withDepression. J Adolesc Health 2018; 63:429-434. [PMID: 30120062 DOI: 10.1016/j.jadohealth.2018.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To better understand links between depressive symptoms and high-risk sexual behavior in young women. METHODS We conducted semistructured interviews with young women from three primary care clinics who reported clinically significant depressive symptoms, had penile-vaginal sexual intercourse within the past 6 months, and met at least one sexual risk criterion (N = 16, age 16-23years, racially/ethnically diverse). We transcribed the interview recordings, organized and coded the data, and conducted a directed content analysis. RESULTS Participants described a complex interrelation between depression and intimate relationships and sexual behavior. Depression had negative effects on relationships, sexual motives and experiences (including safety), and feelings about oneself in sexual situations. Participants reported difficulty in developing and maintaining intimate relationships. Although many participants reported less interest in and emotional energy for sex, several were having sex frequently to manage depressive symptoms. Generally, the young women described sex as unsafe (e.g., no condom) owing to impaired judgment, increased impulsivity, apathy, and alcohol. As a result, sometimes their efforts to feel better by having sex led them to feeling worse (e.g., ashamed and worthless). CONCLUSIONS Depressed young women may limit intimate relationships, yet engage in frequent and unsafe sex to cope with their symptoms. Their efforts to feel better may provide only temporary relief or result in feeling worse. Depressed young women would benefit from tailored interventions that identify and counter unhealthy thoughts, attitudes, behaviors, and patterns related to sexual relationships and behavior; minimize factors that impair healthy decision-making; and foster development of alternative affect regulation strategies.
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Affiliation(s)
- Pamela J Burke
- School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Allegra Spalding
- University of Chicago, Masters Program in Social Service Administration, Chicago, Illinois
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Shrier LA, Burke PJ, Kells M, Scherer EA, Sarda V, Jonestrask C, Xuan Z, Harris SK. Pilot randomized trial of MOMENT, a motivational counseling-plus-ecological momentary intervention to reduce marijuana use in youth. Mhealth 2018; 4:29. [PMID: 30148142 PMCID: PMC6087802 DOI: 10.21037/mhealth.2018.07.04] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ecological momentary interventions (EMIs) influence behavior in real time, in real life. We evaluated trial feasibility and preliminary efficacy of MOMENT, a counseling-plus-EMI to reduce frequent marijuana use in youth in primary care. METHODS Primary care patients age 15-24 years using marijuana at least 3 times/week were randomized to MOMENT [motivational enhancement therapy (MET)/smartphone-based momentary assessment/responsive motivational messaging] vs. No-messages (MET/momentary assessment) vs. MET-only. In MOMENT, two MET sessions were followed by 2 weeks of momentary assessment of marijuana use and factors related to use, with motivational messaging displayed after report of marijuana triggers, desire, use, and effort to avoid use. We evaluated study feasibility (recruitment, retention, and response rates; feedback survey responses) and explored intervention effects on marijuana desire and use at three months with linear mixed effects modeling. RESULTS Seventy youth [mean (M) =20.7 years, 60% female] were assigned to MOMENT (n=27), No-messages (n=15; assignment suspended to enrich other arms), or MET-only (n=28). Most attrition occurred during baseline, before MET. Of those completing MET session 1, 82% completed their assigned treatment and 79% provided 3-month data. Participants highly rated acceptability; comments reflected changing motivation and behavior. Across arms, participants reported significantly lower marijuana use, desire, and problems at follow-up vs. baseline. Momentary marijuana desire declined more in MOMENT vs. MET-only. Marijuana use following a targeted context or behavior was less likely in MOMENT and No-messages, vs. MET-only. CONCLUSIONS The MOMENT intervention is feasible to deliver, acceptable, and potentially efficacious in reducing marijuana desire and use among adolescent and young adults in primary care. A larger randomized trial to evaluate efficacy is warranted.
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Affiliation(s)
- Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela J. Burke
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Meredith Kells
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Emily A. Scherer
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Vishnudas Sarda
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Ross CS, Brooks DR, Aschengrau A, Siegel MB, Weinberg J, Shrier LA. Positive and negative affect following marijuana use in naturalistic settings: An ecological momentary assessment study. Addict Behav 2018; 76:61-67. [PMID: 28756041 DOI: 10.1016/j.addbeh.2017.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Smelov V, Vrbanac A, van Ess EF, Noz MP, Wan R, Eklund C, Morgan T, Shrier LA, Sanders B, Dillner J, de Vries HJC, Morre SA, Dean D. Chlamydia trachomatis Strain Types Have Diversified Regionally and Globally with Evidence for Recombination across Geographic Divides. Front Microbiol 2017; 8:2195. [PMID: 29180986 PMCID: PMC5693916 DOI: 10.3389/fmicb.2017.02195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/25/2017] [Indexed: 11/17/2022] Open
Abstract
Chlamydia trachomatis (Ct) is the leading cause of bacterial sexually transmitted diseases worldwide. The Ct Multi Locus Sequence Typing (MLST) scheme is effective in differentiating strain types (ST), deciphering transmission patterns and treatment failure, and identifying recombinant strains. Here, we analyzed 323 reference and clinical samples, including 58 samples from Russia, an area that has not previously been represented in Ct typing schemes, to expand our knowledge of the global diversification of Ct STs. The 323 samples resolved into 84 unique STs, a 3.23 higher typing resolution compared to the gold standard single locus ompA genotyping. Our MLST scheme showed a high discriminatory index, D, of 0.98 (95% CI 0.97-0.99) confirming the validity of this method for typing. Phylogenetic analyses revealed distinct branches for the phenotypic diseases of lymphogranuloma venereum, urethritis and cervicitis, and a sub-branch for ocular trachoma. Consistent with these findings, single nucleotide polymorphisms were identified that significantly correlated with each phenotype. While the overall number of unique STs per region was comparable across geographies, the number of STs was greater for Russia with a significantly higher ST/sample ratio of 0.45 (95% CI: 0.35-0.53) compared to Europe or the Americas (p < 0.009), which may reflect a higher level of sexual mixing with the introduction of STs from other regions and/or reassortment of alleles. Four STs were found to be significantly associated with a particular geographic region. ST23 [p = 0.032 (95% CI: 1-23)], ST34 [p = 0.019 (95% CI: 1.1-25)]; and ST19 [p = 0.001 (95% CI: 1.7-34.7)] were significantly associated with Netherlands compared to Russia or the Americas, while ST 30 [p = 0.031 (95% CI: 1.1-17.8)] was significantly associated with the Americas. ST19 was significantly associated with Netherlands and Russia compared with the Americans [p = 0.001 (95% CI: 1.7-34.7) and p = 0.006 (95% CI: 1.5-34.6), respectively]. Additionally, recombinant strains were ubiquitous in the data set [106 (32.8%)], although Europe had a significantly higher number than Russia or the Americas (p < 0.04), the majority of which were from Amsterdam [43 (87.8%) of 49)]. The higher number of recombinants in Europe indicates selective pressure and/or adaptive diversification that will require additional studies to elucidate.
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Affiliation(s)
- Vitaly Smelov
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Karolinska Institute, Stockholm, Sweden
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Alison Vrbanac
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | - Eleanne F. van Ess
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, Netherlands
| | - Marlies P. Noz
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, Netherlands
| | - Raymond Wan
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | | | - Tyler Morgan
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | - Lydia A. Shrier
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Blake Sanders
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
| | | | - Henry J. C. de Vries
- Center for Infection and Immunology Amsterdam, Academic Medical Center, Amsterdam, Netherlands
- Department of Dermatology, Academic Medical Center, Amsterdam, Netherlands
- STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, Netherlands
| | - Servaas A. Morre
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, Netherlands
- Institute of Public Health Genomics, Department of Genetics and Cell Biology, Research Institute GROW (School for Oncology and Developmental Biology), Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Deborah Dean
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, CA, United States
- Department of Bioengineering, University of California, Berkeley, Berkeley, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
- Departments of Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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Scherer EA, Huang L, Shrier LA. Application of Correlated Time-to-Event Models to Ecological Momentary Assessment Data. Psychometrika 2017; 82:233-244. [PMID: 27044277 PMCID: PMC5050055 DOI: 10.1007/s11336-016-9495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 06/05/2023]
Abstract
Ecological momentary assessment data consist of in-the-moment sampling several times per day aimed at capturing phenomena that are highly variable. When research questions are focused on the association between a construct measured repeatedly and an event that occurs sporadically over time interspersed between repeated measures, the data consist of correlated observed or censored times to an event. In such a case, specialized time-to-event models that account for correlated observations are required to properly assess the relationships under study. In the current study, we apply two time-to-event analysis techniques, proportional hazards, and accelerated failure time modeling, to data from a study of affective states and sexual behavior in depressed adolescents and illustrate differing interpretations from the models.
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Affiliation(s)
- Emily A Scherer
- Division of Biostatistics, Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03766 , USA.
| | - Lin Huang
- Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lydia A Shrier
- Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Shrier LA, Spalding A. "Just Take a Moment and Breathe and Think": Young Women with Depression Talk about the Development of an Ecological Momentary Intervention to Reduce Their Sexual Risk. J Pediatr Adolesc Gynecol 2017; 30:116-122. [PMID: 27575408 DOI: 10.1016/j.jpag.2016.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/26/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE Depressed young women are at increased risk for adverse outcomes related to sexual behavior, including unintended pregnancy, HIV, and other sexually transmitted infections. Brief sexual risk reduction interventions have not targeted depressed young women's specific needs for affect management and impulse control. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We interviewed depressed young women ages 15-23 years engaging in sexual risk behavior about a proposed intervention approach. The approach was described as in-person counseling and cognitive-behavioral skills training, followed by an ecological momentary intervention (EMI) delivered via smartphone application for 4 weeks. The EMI would include reporting multiple times a day on affective states, self-efficacy for safer sex behavior, and sexual behavior, and receiving responsive messages to provide support and prompt use of cognitive-behavioral skills. Participants provided their perspectives on comfort, usability, burden, confidentiality, and potential efficacy of the EMI and recommended message content. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS Thematic saturation was reached with 16 interviews. Participants expressed positive opinions about the EMI. They believed that reporting at random times would help them to recognize their feelings, receiving the messages would be reassuring, and overall the smartphone application would be experienced as therapeutic. They desired a high degree of personalization of the message quality, style, and voice, and provided a wide variety of message content. CONCLUSION Depressed young women believed that a flexible, personalized approach to mobile momentary intervention for addressing the link between their symptoms and behavior would be acceptable, supportive, and effective in reducing sexual risk.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Allegra Spalding
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Harstad E, Sideridis G, Sherritt L, Shrier LA, Ziemnik R, Levy S. Concurrent Validity of Caffeine Problems and Diagnostic Criteria for Substance Use Disorders. J Caffeine Res 2016; 6:141-147. [PMID: 28078168 DOI: 10.1089/jcr.2016.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The DSM-5 proposes caffeine use disorder (CUD) as a condition for further study. The objective of this study was to report on the prevalence of CUD and rates of endorsement for each substance use disorder (SUD) criterion in relation to caffeine compared to alcohol and marijuana in a sample of adolescents presenting for medical care in the primary, adolescent, and substance use clinics at an academic medical center. Methods: A convenience sample of patients (N = 213; 66.7% female) aged 12-17 presenting for medical care completed the Composite Diagnostic Interview-Substance Abuse Module questionnaire, with questions regarding use of caffeine, alcohol, and marijuana. Descriptive analyses were used to determine prevalence of CUD and frequency of each endorsed SUD criterion as applied to caffeine versus alcohol or marijuana. Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) were used to determine psychometric properties for CUD. Results: The majority of subjects (N = 153) reported past 30-day caffeine use and of these, six (4%) met criteria for CUD. All six also met criteria for either alcohol and/or marijuana use disorders. Of the three essential CUD criteria (failure to quit, use despite harm, and withdrawal), both harm and withdrawal were endorsed significantly more often in relation to caffeine versus alcohol. Descriptive fit indices for the CUD model were excellent (CFI = 0.994, TLI = 0.991). Conclusions: In our sample, the proportion of adolescents that met proposed CUD criteria was low, suggesting that the proposed criteria would not lead to overdiagnosis of CUD. CUD was highly correlated with other SUDs.
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Affiliation(s)
- Elizabeth Harstad
- Division of Developmental Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - Georgios Sideridis
- Division of Developmental Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - Lon Sherritt
- Division of Developmental Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - Rosemary Ziemnik
- Division of Developmental Medicine, Boston Children's Hospital , Boston, Massachusetts
| | - Sharon Levy
- Division of Developmental Medicine, Boston Children's Hospital , Boston, Massachusetts
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Shrier LA, Blood EA. Momentary Desire for Sexual Intercourse and Momentary Emotional Intimacy Associated With Perceived Relationship Quality and Physical Intimacy in Heterosexual Emerging Adult Couples. J Sex Res 2016; 53:968-978. [PMID: 26606678 DOI: 10.1080/00224499.2015.1092104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual desire and emotional intimacy are central to relationships, yet little is known about how these feelings vary within and between partners or relate to dyad functioning. We explored magnitude and stability of momentary sexual desire and emotional intimacy in relation to quality and functioning of heterosexual relationships. After reporting perceived relationship quality and physical intimacy enjoyment, members of 18 emerging adult heterosexual couples reported momentary partner-specific sexual desire and emotional intimacy several times a day for two weeks (2,224 reports). Mean and mean squared successive difference (MSSD) characterized magnitude and stability, respectively, of the momentary states. Regression models of relationship outcomes examined influence of the male versus female partner having greater or more stable desire and intimacy. Sexual desire and emotional intimacy magnitude and stability were associated with relationship quality and physical intimacy enjoyment differently for men versus women. Gender-specific differences between partners also predicted relationship outcomes. Men particularly perceived higher relationship quality and enjoyed physical intimacy more when they had higher and more stable sexual desire and their female partners had more stable emotional intimacy. Partner differences in momentary sexual desire and emotional intimacy may contribute to understanding quality and functioning of heterosexual relationships.
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Affiliation(s)
- Lydia A Shrier
- a Division of Adolescent/Young Adult Medicine , Boston Children's Hospital
- b Department of Pediatrics , Harvard Medical School
| | - Emily A Blood
- b Department of Pediatrics , Harvard Medical School
- c Clinical Research Center , Boston Children's Hospital
- d Department of Community and Family Medicine , Geisel School of Medicine at Dartmouth
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Sojar SH, Shrier LA, Ziemnik RE, Sherritt L, Spalding AL, Levy S. Symptoms Attributed to Consumption of Caffeinated Beverages in Adolescents. J Caffeine Res 2015; 5:187-191. [PMID: 26649254 PMCID: PMC4663645 DOI: 10.1089/jcr.2015.0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose: Pediatric caffeine use has become increasingly prevalent. The American Academy of Pediatrics discourages caffeine use by children and adolescents due to its adverse impact on sleep and blood pressure. The objective of this study was to measure prevalence of physical and emotional symptoms related to caffeine consumption among adolescents receiving primary care. Methods: A convenience sample of patients (N = 179; 73% female) aged 12-17 presenting for routine primary care completed the Composite International Diagnostic Interview Substance Abuse Module questionnaire, which included questions regarding use of caffeine. Descriptive statistics were used to summarize prevalence of caffeine use and caffeine-related symptoms. Associations of number of caffeine-related symptoms with age, gender, and race/ethnicity were also analyzed. Results: Sixty-seven percent of participants (n = 120) reported past 30-day caffeinated beverage consumption. Of those, 68% (n = 82) reported at least one symptom or problem attributed to caffeine use or withdrawal, including caffeine cravings, 24% (n = 29); frequent urination, 21% (n = 25); difficulty falling asleep, 18% (n = 22); and feeling anxious, 3.3% (n = 4). Conclusions: In our sample, caffeinated beverage consumption by adolescents was frequently associated with physical and emotional symptoms, as well as problems attributed to use.
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Affiliation(s)
| | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Rosemary E. Ziemnik
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lon Sherritt
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Allegra L. Spalding
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Levy
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
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Abstract
UNLABELLED ABSTRACT. among young people. This study examined how positive and negative affect differ before marijuana use compared with other times. METHOD Forty medical outpatients ages 15-24 years who used marijuana recreationally at least twice a week (M = 18.7 years; 58% female) reported momentary positive affect, negative affect, companionship, perceived ease of obtaining marijuana, and marijuana use several times a day for 2 weeks on a handheld computer. Mean momentary positive affect and negative affect scores in the 24 hours leading up to a marijuana use event (n = 294) were compared with affect scores in times further from subsequent use. Generalized estimating equation models considered as potential moderators perceived ease of obtaining marijuana and being with friends. RESULTS Positive affect did not differ in the 24 hours before marijuana use compared with times further before use. Negative affect was significantly higher before marijuana use compared with other times. Being with friends and perceived easy marijuana availability did not moderate the associations. The association between negative affect and subsequent marijuana use was attenuated when negative affect was examined only for the moment just before use, suggesting that use may follow a period of increased negative affect. CONCLUSIONS The findings support an affect regulation model for marijuana use among frequently using youth. Specifically, these youth may use marijuana to manage increased negative affect.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Craig S Ross
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Emily A Blood
- Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts
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Shrier LA, Scherer EB. It depends on when you ask: motives for using marijuana assessed before versus after a marijuana use event. Addict Behav 2014; 39:1759-65. [PMID: 25123342 DOI: 10.1016/j.addbeh.2014.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/07/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Marijuana use motives are typically evaluated retrospectively using measures that summarize or generalize across episodes of use, which may compromise validity. Using Ecological Momentary Assessment data, we examined the main reason for a specific marijuana use event measured both prospectively and retrospectively. We then determined reason types, event characteristics, and user characteristics that predicted change in reason. METHODS Thirty-six medical outpatients age 15 to 24 years who used marijuana two times a week or more used a handheld computer to select their main reason for use from the five categories of the Marijuana Motives Measure (Simons, Correia, & Carey, 1998) just before and after each time they used marijuana over two weeks (n=263 events with before/after reason). The reasons were examined individually and according to dimensions identified in motivational models of substance use (positive/negative, internal/external). RESULTS The reason assessed before use changed to a different reason after use for 20% of events: 10% of events for pleasure; 21%, to cope; 35%, to be more social; 55%, to expand my mind; and 100%, to conform. In the multivariable model, external and expansion reasons each predicted change in reason for use (p<0.0001 and p=0.001, respectively). Youth were also more likely to change their reason if older (p=0.04), if male (p=0.02), and with weekend use (p=0.002). CONCLUSION Retrospective assessments of event-specific motives for marijuana use may be unreliable and therefore invalid for a substantial minority of events, particularly if use is for external or expansion reasons.
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Crosby R, Graham C, Milhausen R, Sanders S, Yarber W, Shrier LA. Associations between rushed condom application and condom use errors and problems. Sex Transm Infect 2014; 91:275-7. [PMID: 25391833 DOI: 10.1136/sextrans-2013-051491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/28/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether any of four condom use errors/problems occurred more frequently when condom application was 'rushed' among a clinic-based sample from three US states. METHODS A convenience sample (n=512) completed daily electronic assessments including questions about condom use being rushed and also assessed condom breakage, slippage, leakage and incomplete use. RESULTS Of 8856 events, 6.5% (n=574) occurred when application was rushed. When events involved rushed condom application, the estimated odds of breakage and slippage were almost doubled (estimated OR (EOR)=1.90 and EOR=1.86). Rushed application increased the odds of not using condoms throughout sex (EOR=1.33) and nearly tripled the odds of leakage (EOR=2.96). With one exception, all tests for interactions between gender and rushed application and between age and rushed application were not significant (p values>0.10). CONCLUSIONS This event-level analysis suggests that women and men who perceive that condom application was rushed are more likely to experience errors/problems during the sexual event that substantially compromise the protective value of condoms against disease and pregnancy. Educational efforts emphasising the need to allow ample time for condom application may benefit this population.
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Affiliation(s)
- Richard Crosby
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
| | - Cynthia Graham
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA Department of Psychology, Southampton University, Southampton, UK
| | - Robin Milhausen
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA Department of Family Relations and Applied Nutrition, University of Guelph, Ontario, Canada
| | - Stephanie Sanders
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - William Yarber
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Kendall AD, Wilt J, Walls CE, Scherer EA, Beardslee WR, Revelle W, Shrier LA. The Social Context of Positive and Negative Affective States in Depressed Youth. Journal of Social and Clinical Psychology 2014. [DOI: 10.1521/jscp.2014.33.9.805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Adolescent substance use is common and is associated with serious mental, physical, and social risks, warranting systematic screening in the primary care setting. It is important for clinicians to become familiar with Screening, Brief Intervention, and Referral to Treatment (SBIRT), including administration of validated screening tools to identify level of risk associated with substance use and application of appropriate brief interventions. Positive reinforcement and brief advice is indicated for those adolescents with no or minimal risk for a substance use disorder. Providing a brief intervention using motivational interviewing strategies with subsequent close clinical follow-up is warranted when an adolescent meets criteria for a mild to moderate substance use disorder. Referral to treatment is recommended in cases of severe substance use. Immediate action, including breaking confidentiality, may be necessary when an adolescent's behavior raises acute safety concerns. Making time to interview adolescents alone is essential. It is also important to review the limitations of confidentiality with patients and parents/guardians and offer them strategies to discuss sensitive issues with their adolescents. Available resources for adolescents, parents/guardians, and clinicians regarding the risks of adolescent substance use and evidence-based treatment options can be used to support implementation of SBIRT in adolescent primary care.
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Abstract
IMPORTANCE Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions. OBJECTIVE To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use. DESIGN, SETTING, AND PARTICIPANTS Adolescent patients (age range, 12-17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview-Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses. MAIN OUTCOMES AND MEASURES For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview-Substance Abuse Module as the criterion standard. RESULTS Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84% (95% CI, 76%-89%) for identifying nontobacco substance use, 90% (95% CI, 77%-96%) and 94% (95% CI, 89%-96%) for substance use disorders, 100% and 94% (95% CI, 90%-96%) for severe substance use disorders, and 75% (95% CI, 52%-89%) and 98% (95% CI, 95%-100%) for nicotine dependence. No significant differences were found in sensitivity or specificity between the full tool and the Screening to Brief Intervention. CONCLUSIONS AND RELEVANCE A single screening question assessing past-year frequency use for 8 commonly misused categories of substances appears to be a valid method for discriminating among clinically relevant risk categories of adolescent substance use.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance Abuse Program, Boston Children’s Hospital, Boston, Massachusetts2Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Roger Weiss
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts5Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | - Lon Sherritt
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts6Center for Adolescent Substance Abuse Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Rosemary Ziemnik
- Adolescent Substance Abuse Program, Boston Children’s Hospital, Boston, Massachusetts2Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Allegra Spalding
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Shari Van Hook
- Adolescent Substance Abuse Program, Boston Children’s Hospital, Boston, Massachusetts2Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts6Center for
| | - Lydia A. Shrier
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts7Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
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Wallace AR, Blood EA, Crosby RA, Shrier LA. Differences in correlates of condom use between young adults and adults attending sexually transmitted infection clinics. Int J STD AIDS 2014; 26:526-33. [PMID: 25070945 DOI: 10.1177/0956462414545525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/07/2014] [Indexed: 11/15/2022]
Abstract
Despite developmental differences between young adults and adults, studies of condom use have not typically considered young adults as a distinct age group. This study sought to examine how condom use and its correlates differed between high-risk young adults and adults. Sexually transmitted infection (STI) clinic patients (n = 763) reported STI history, contraception, negative condom attitudes, fear of partner reaction to condom use and risky behaviours. Past 3-month condom use was examined as unprotected vaginal sex (UVS) acts, proportional condom use and consistent condom use. Regression models tested associations of age group and potential correlates with each condom use outcome. Interaction models tested whether associations differed by age group. Proportional condom use was greater in young adults than adults (mean 0.55 vs. 0.47); UVS and consistent condom use were similar between age groups. Young adults with a recent STI reported less condom use, whereas for older adults, a distant STI was associated with less condom use, compared to others in their age groups. Negative condom attitudes were more strongly linked to UVS acts for younger versus older adults. STI prevention efforts for younger adults may be improved by intensifying counselling about condom use immediately following STI diagnosis and targeting negative condom attitudes.
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Affiliation(s)
- Amanda R Wallace
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Emily A Blood
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Richard A Crosby
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Crosby RA, Charnigo R, Shrier LA. Prospective associations between perceived barriers to condom: use and "perfect use". Am J Prev Med 2014; 47:70-2. [PMID: 24746374 DOI: 10.1016/j.amepre.2014.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Identifying malleable predictors of condom use in a clinic-based population may benefit efforts to prevent sexually transmitted infections (STIs). PURPOSE To prospectively test associations between three measures (relational-trust factors, fit and feel, and dislike of condom use) and perfect condom use in patients attending clinics diagnosing STIs. METHODS A convenience sample was recruited from five clinics in three U.S. cities. Data were collected from December 2007 through April 2011. Daily electronic diaries were completed for up to 180 days. Occasions of penile-vaginal intercourse (PVI) involving condom use without any of four errors/problems were classified as "perfect use." Three subscales (relational-trust factors, fit and feel, and dislike of condom use) were developed from baseline data. Generalized estimating equations were used to account for non-independence of PVI events. RESULTS Among 17,156 reported occasions of PVI, condoms were either not used or used with errors/problems in 8,857 (51.6%) instances. The remaining 8,829 occasions (48.4%) involved perfect use. Relational-trust (p=0.054) and fit and feel (p=0.13) issues were not significantly associated with perfect use. Dislike of condom use (p=0.005) was significantly associated with perfect use (estimated OR=0.93, 95% CI=0.89, 0.98). Significant interactions with race, age, or gender were not observed. CONCLUSIONS Clinic attendees may be more likely to use condoms perfectly if three perceptions are reduced in magnitude: I won't use condoms, condoms spoil the mood, and I get turned off when my partner suggests we use condoms. Findings support a paradigm shift in the way clinics promote condom use to patients.
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Affiliation(s)
- Richard A Crosby
- College of Public Health, University of Kentucky, Lexington, Kentucky; Rural Center for AIDS/STD Prevention, The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana.
| | - Richard Charnigo
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Crosby RA, Milhausen RR, Graham CA, Yarber WL, Sanders SA, Charnigo R, Shrier LA. Likelihood of Condom Use When Sexually Transmitted Diseases Are Suspected: Results From a Clinic Sample. Health Educ Behav 2014; 41:449-54. [PMID: 24722217 DOI: 10.1177/1090198114529588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the event-level associations between perceived risk of sexually transmitted disease (STD) acquisition/transmission and condom use during penile-vaginal intercourse (PVI) among STD clinic attendees. METHOD A convenience sample (N = 622) completed daily electronic assessments. Two questions were proxies of perceived risk: suspicion that the partner might currently have an STD and that "you" might currently have an STD. Participants reported whether condoms were used with PVI events in the past 24 hours. Generalized estimating equations determined the association between each of the perceived risk variables and event-level condom use. RESULTS For the model pertaining to suspicion of sex partner infection, there were 16,674 events of PVI, with condom use during 10,552 of these events. The effect of current suspicion was significant after adjusting for gender and whether participants identified as African American/Black (estimated odds ratio = 2.17, 95% confidence interval = 1.57-3.00, P = .0001). The model pertaining to suspicion of self-infection included 16,679 events of penile-vaginal sex, with condom use during 10,557 of these events. Again, the effect of current suspicion was significant after adjusting for gender and African American/Black race (estimated odds ratio = 2.05, 95% confidence interval = 1.43-2.40, P = .0001). Tests for interactions with gender and with race were nonsignificant (all Ps > .25). CONCLUSION Using an event-level research design, strong associations were found between perceptions of STD risk and condom use in a clinical population. Health care providers and other professionals may indirectly promote condom use by helping clinic patients realistically evaluate their risk of having sex with infected partners or of being a source of STD transmission to others.
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Affiliation(s)
- Richard A Crosby
- University of Kentucky, Lexington, KY, USA Indiana University, Bloomington, IN, USA
| | - Robin R Milhausen
- Indiana University, Bloomington, IN, USA University of Guelph, Guelph, Ontario, Canada
| | - Cynthia A Graham
- Indiana University, Bloomington, IN, USA University of Southampton, Southampton, UK
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Black SK, de Moor C, Kendall AD, Shrier LA. Feasibility of Momentary Sampling Assessment of Cannabis Use in Adolescents and Young Adults. Journal of Child & Adolescent Substance Abuse 2014. [DOI: 10.1080/1067828x.2013.786923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Carl de Moor
- b Health Outcomes and Pharmacoeconomics , Morrisville , NC , USA
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Shrier LA, Rhoads A, Burke P, Walls C, Blood EA. Real-time, contextual intervention using mobile technology to reduce marijuana use among youth: a pilot study. Addict Behav 2014; 39:173-80. [PMID: 24139665 DOI: 10.1016/j.addbeh.2013.09.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/19/2013] [Accepted: 09/09/2013] [Indexed: 11/28/2022]
Abstract
We evaluated the feasibility, acceptability, and potential efficacy of MOMENT, an intervention to reduce youth marijuana use that combines brief motivational enhancement therapy with mobile self-monitoring and responsive messaging. At baseline, primary care patients ages 15-24 who used marijuana frequently (at least 3 times per week) completed a recall assessment, then 1 week of mobile momentary and daily reports on use-related factors. For the intervention, youth participated in two motivational enhancement therapy sessions, during which they identified their top-3 social and emotional triggers for use and discussed healthy ways to manage them. They then completed two weeks of mobile reports. Upon reporting a top-3 trigger for use, desire to use, or recent use, they received a message supporting self-efficacy and prompting consideration of coping strategies. Generalized estimating equations examined changes in momentary-, daily-, and individual-level measures on 3-month recall and mobile assessments. Twenty-seven youth (M=19.2 years, 70% female) enrolled; there were 377-677 momentary and 50-106 daily reports per study phase. Participants reported reading the messages and finding them motivating, being comfortable with participation, and not experiencing the study as burdensome. Although proportion of momentary reports of being in a top-3 trigger context did not change (36%-43%), marijuana desire in a top-3 trigger context and marijuana use after top-3 trigger exposure decreased over the study (p<.0001 and p=.03, respectively). Daily- and individual-level measures showed similar, non-significant, improvements. The MOMENT intervention appears feasible, well-accepted, and potentially efficacious for youth who use marijuana frequently.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Crosby RA, Milhausen RR, Graham CA, Yarber WL, Sanders SA, Charnigo R, Shrier LA. Condom use motivations and selected behaviours with new versus established sex partners. Sex Health 2014; 11:252-7. [DOI: 10.1071/sh13159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/06/2014] [Indexed: 11/23/2022]
Abstract
Objective To compare condom use motives and behaviours in the context of penile–vaginal intercourse (PVI) with new versus established sexual partners, using daily event-level data among a clinic-recruited sample. Methods: Participants (ages 15–65 years old) were recruited from five sexually transmissible infection (STI) clinics in three United States cities. They were provided with personal digital assistants and instructed to respond to daily questionnaire items regarding PVI events from the past 24 h. Generalised estimations equations were used to make inferences on age-adjusted estimated odds ratios, comparing events occurring with established versus new partners. Results: For males, pregnancy prevention was a more common motivation for condom use in new relationships (P < 0.001). Males with new sex partners were more likely to report condom use (P < 0.005) and also reported fewer errors or problems in condom use with new sex partners (P < 0.001). For females, pregnancy prevention (P = 0.03), STI acquisition (P < 0.001) and STI transmission (P = 0.005) were more likely to be motives for condom use with new versus established partners. Also, females with new sex partners were more likely to report condom use (P < 0.001) as well as using multiple condoms during a single event (P = 0.03). Conclusion: Event-level findings suggest that condom use motivations and behaviours vary depending on whether PVI occurs between established versus new sex partners. Condom use is more likely for PVI with new partners, but other condom-associated behaviours and motivations differ between females and males.
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Shrier LA, Rhoads AM, Fredette ME, Burke PJ. "Counselor in Your Pocket": Youth and Provider Perspectives on a Mobile Motivational Intervention for Marijuana Use. Subst Use Misuse 2014; 49:134-144. [PMID: 24000892 DOI: 10.3109/10826084.2013.824470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Previous interventions for marijuana use have been administered out of the real-life contexts in which use occurs. In 2010, we interviewed youth aged 15-24 years who use marijuana frequently (n = 8) and providers who treat them (n = 6) on the acceptability and utility of a mobile intervention involving momentary self-monitoring of use-related contexts and responsive motivational messaging following clinic-based brief motivational enhancement therapy. Thematic analysis was used to examine youth and provider perspectives on the mobile intervention. Results suggest that mobile technology is a promising tool for brief interventions to reduce youth marijuana use and warrants further development.
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Affiliation(s)
- Lydia A Shrier
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
| | - Amanda M Rhoads
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
| | - Meghan E Fredette
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
| | - Pamela J Burke
- a Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts, USA
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Blood EA, Shrier LA. The temporal relationship between momentary affective states and condom use in depressed adolescents. Arch Sex Behav 2013; 42:1209-16. [PMID: 23297149 DOI: 10.1007/s10508-012-0048-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 10/18/2012] [Accepted: 10/18/2012] [Indexed: 05/12/2023]
Abstract
Depressed adolescents are more likely to engage in sexual risk behaviors than their non-depressed peers. The objectives of this study were (1) to examine whether affective states predicted subsequent condom use, directly or indirectly through contextual factors and (2) to compare results obtained from structural equation models versus non-linear mixed effects models. This study used ecological momentary assessment to collect data on in-the-moment affective states and sexual behavior from 51 depressed adolescents (7 male, 44 female) aged 15-22 years. The association between positive and negative affect and condom use during a subsequent sex event was explored using several structural equation models and non-linear mixed effects models. Potential mediation by substance use before sex, partner type, reason for sex, and who wanted sex was examined. Neither positive nor negative affect was directly associated with condom use in any models; however, negative affect was associated with increased likelihood of sex with a non-main partner, which, in turn, was associated with increased condom use. Both structural equation models and non-linear mixed effects models successfully modeled the relationship between affect and condom use in momentary data while correctly accounting for the correlation of multiple observations from the same individual. The benefit of structural equation modeling was the ability to directly model the mediation of this effect by contextual factors. In this sample of depressed adolescents, negative and positive affect did not appear to be directly predictive of condom use during a subsequent sex event, although may indirectly affect condom use through sex with a non-main partner.
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Affiliation(s)
- Emily A Blood
- Clinical Research Center, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA,
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Crosby R, Shrier LA, Charnigo R, Sanders SA, Graham CA, Milhausen R, Yarber WL. Negative perceptions about condom use in a clinic population: comparisons by gender, race and age. Int J STD AIDS 2013; 24:100-5. [PMID: 23467292 DOI: 10.1177/0956462412472295] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to elucidate the associations of 13 items assessing negative perceptions about condom use with gender, age and race in a sample of clinic attendees. Patients from four clinics, in three US cities, were recruited (N = 928). Data were collected using audio-computer-assisted self-interviewing. The primary measure was a 13-item adapted version of the Condom Barriers Scale. Logistic regression and chi-square tests were employed to relate the 13 items to gender, age and race. Gender, race and age all had significant associations with negative perceptions of condoms and their use. A primary finding was a large number of significant differences between men and women, with negative perceptions more common among women than among men. For African Americans, especially women, negative perceptions were more common among older participants than among younger participants. In conclusion, important demographic differences regarding negative perceptions may inform the tailoring of intervention efforts that seek to rectify negative perceptions about condoms and thus promote condom use among individuals at risk for sexually transmitted infections (STIs) in the USA. On the other hand, our findings also suggest that the majority of STI clinic attendees may hold positive perceptions about condoms and their use; maintaining and building upon these positive perceptions via education, counselling, and access is also important.
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Affiliation(s)
- R Crosby
- College of Public Health at the University of Kentucky
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46
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Levy S, A. Shrier L. Screening and Brief Intervention for Adolescent Substance Use in Medical Settings. APS 2013. [DOI: 10.2174/2210676611303020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Blood EA, Kalish LA, Shrier LA. Estimating Heterogeneous Intra-class Correlation Coefficients in Dyadic Ecological Momentary Assessment. J Mod App Stat Meth 2013. [DOI: 10.22237/jmasm/1367382120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Emily A. Blood
- Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School
| | - Leslie A. Kalish
- Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School
| | - Lydia A. Shrier
- Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School
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Abstract
OBJECTIVES This study investigates how characteristics of young adolescents' screen media use are associated with their BMI. By examining relationships between BMI and both time spent using each of 3 screen media and level of attention allocated to use, we sought to contribute to the understanding of mechanisms linking media use and obesity. METHODS We measured heights and weights of 91 13- to 15-year-olds and calculated their BMIs. Over 1 week, participants completed a weekday and a Saturday 24-hour time-use diary in which they reported the amount of time they spent using TV, computers, and video games. Participants carried handheld computers and responded to 4 to 7 random signals per day by completing onscreen questionnaires reporting activities to which they were paying primary, secondary, and tertiary attention. RESULTS Higher proportions of primary attention to TV were positively associated with higher BMI. The difference between 25th and 75th percentiles of attention to TV corresponded to an estimated +2.4 BMI points. Time spent watching television was unrelated to BMI. Neither duration of use nor extent of attention paid to video games or computers was associated with BMI. CONCLUSIONS These findings support the notion that attention to TV is a key element of the increased obesity risk associated with TV viewing. Mechanisms may include the influence of TV commercials on preferences for energy-dense, nutritionally questionable foods and/or eating while distracted by TV. Interventions that interrupt these processes may be effective in decreasing obesity among screen media users.
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Affiliation(s)
- David S Bickham
- Center on Media and Child Health, Boston Children’s Hospital, Boston, MA 02115, USA.
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Borus JS, Blood E, Volkening LK, Laffel L, Shrier LA. Momentary assessment of social context and glucose monitoring adherence in adolescents with type 1 diabetes. J Adolesc Health 2013; 52:578-83. [PMID: 23298986 PMCID: PMC4079549 DOI: 10.1016/j.jadohealth.2012.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/29/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the associations between momentary social context and glucose monitoring adherence in adolescents with type 1diabetes (T1D). METHODS For 14 days, patients (14-18 years old, T1D duration >1 year) of a pediatric diabetes clinic carried handheld computers that prompted them to report their location, companionship, and attitudes toward companions at the times they usually checked their glucose, and again 30 minutes later to report whether they checked their glucose and, if not, why. Associations between social context factors and checking glucose (adherence) were analyzed using logistic generalized estimating equations and adjusted for age, sex, duration of T1D, and pump use. RESULTS Thirty-six participants (mean age 16.6 ± 1.5 years, mean duration of T1D 8.7 ± 4.4 years) completed 971 context and 1,210 adherence reports, resulting in 805 paired reports. Median signal response rate was 63%. The odds of checking glucose was higher when participants expressed very strong desire to blend in (adjusted odds ratio [AOR] = 2.30, 95% confidence interval 1.07-4.94, p = .03). Strong desire to impress others was associated with decreased likelihood of checking glucose (AOR = .52, 95% confidence interval .28-.97, p = .04.) Location, solitude, type of companion, and attitudes toward companions were not significantly associated with checking glucose. CONCLUSIONS Desire to blend in may support glucose monitoring adherence and desire to impress others may impede this behavior in adolescents with T1D. Other dimensions of social context were not linked to checking glucose in this study.
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Affiliation(s)
- Joshua S. Borus
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Emily Blood
- Clinical Research Center, Boston Children's Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Lori Laffel
- Department of Pediatrics, Harvard Medical School, Boston, MA,Genetics & Epidemiology Section, Joslin Diabetes Center, Boston, MA,Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA
| | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
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Abstract
We investigated associations of sexual desire with time of day, physical and social context, and positive and negative affect using momentary sampling in 44 depressed young women (mean age = 18). Analyses revealed that depressed young women experienced sexual desire when with their boyfriends and later in the evening. Sexual desire was also positively associated with positive affect. Sexual desire was not associated with negative affect or physical context. This research suggests that sexual desire is experienced by depressed young women in normative developmental social contexts. Our findings may help clinicians and sexual health educators in correcting the myth that depressed women do not have sexual desire.
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Affiliation(s)
- Clare M Mehta
- a Division of Adolescent/Young Adult Medicine , Children's Hospital Boston
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